Lung Cancer

LUNG CANCER

illustration showing the lungs in relation to the trachea, bronchus and bronchioles with details of the bronchioles showing the alveoli

Cancer can start any place in the body. Cancer that starts in the lung is called lung cancer. It starts when cells in the lung grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.

Cancer cells can spread to other parts of the body. Cancer cells in the lung can sometimes travel to the brain and grow there. When cancer cells do this, it’s called metastasis (muh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones from the lung.

Cancer is always named for the place where it starts. So when lung cancer spreads to the brain (or any other place), it’s still called lung cancer. It’s not called brain cancer unless it starts from cells in the brain.

Are there different kinds of lung cancer?
There are 2 main types of lung cancer:

  • Small cell lung cancer
  • Non-small cell lung cancer

They are not treated the same way. Your doctor can tell you more about the type you have.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Squamous cell carcinoma, adenocarcinoma, and large cell carcinoma are all subtypes of NSCLC.

Questions to ask the doctor

  • Why do you think I have lung cancer?
  • Is there a chance I don’t have cancer?
  • Would you please write down the kind of cancer you think I might have?
  • What will happen next?

How does the doctor know I have lung cancer?
The doctor asks you questions about your health and does a physical exam. If signs are pointing to lung cancer, more tests will be done.

Tests that may be done
Here are some of the tests you may need:

  • Chest x-ray: This is often the first test done to look for spots on your lungs. If a change is seen, you’ll need more tests.
  • CT scan: This is also called a “CAT scan.” It’s a special kind of x-ray that takes pictures of your insides. CT scans can also be used to help do a biopsy (see below).
  • PET scan: In this test, you are given a special type of sugar that can be seen inside your body with a camera. If there’s cancer, the sugar shows up as “hot spots” where the cancer is found. This test is useful when your doctor thinks the cancer has spread, but doesn’t know where.
  • Bronchoscopy (brong-KOS-kuh-pee): A thin, lighted, flexible tube is passed through your mouth into the bronchi. The doctor can look through the tube to find tumors. The tube also can be used to do a biopsy.
  • Blood tests: Blood tests are not used to find lung cancer, but they are done to tell the doctor more about your health.
  • Lung biopsy: In a biopsy (BY-op-see), the doctor takes out a small piece of tissue or fluid where the cancer seems to be. It’s checked for cancer cells. A biopsy is the best way to tell for sure if you have cancer. There are many types of biopsies and ways to do them. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.

Questions to ask the doctor

  • What tests will I need to have?
  • Who will do these tests?
  • Where will they be done?
  • Who can explain them to me?
  • How and when will I get the results?
  • Who will explain the results to me?
  • What do I need to do next?

How serious is my cancer?
If you have non-small cell lung cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 2” or “stage 3.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the spread of the cancer through the lung. It also tells if the cancer has spread to other organs of your body that are close by or farther away.

Your stage can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, such as stage 4, means a more serious cancer that has spread beyond the lungs. Be sure to ask the doctor about the cancer stage and what it means for you.

Questions to ask the doctor

  • Do you know the stage of the cancer?
  • If not, how and when will you find out the stage of the cancer?
  • Would you explain to me what the stage means in my case?
  • Based on the stage of the cancer, how long do you think I’ll live?
  • What will happen next?

What kind of treatment will I need?
There are many ways to treat lung cancer, but the main types of treatment are local or systemic.
Surgery and radiation are used to treat only the cancer. They do not affect the rest of the body. This is called local treatment.

Chemo drugs go through the whole body. They can reach cancer cells anywhere in the body. They are called systemic (pronounced sis-TEM-ick) treatment.

Doctors may use both local and systemic treatments to treat lung cancer. The treatment plan that’s best for you will depend on:

  • The stage of the cancer
  • The chance that a type of treatment will help
  • Your age
  • Other health problems you have
  • Your feelings about the treatment and the side effects that may come with it

Surgery
If your cancer is in an early stage, your doctor may suggest surgery (SUR-jur-ee), along with other treatments. All or part of your lung may be taken out. If surgery can be done, it offers the best chance of a cure.

Sometimes, fluid collects in the chest and causes breathing problems. This fluid can be taken out by putting a small tube in the chest. After the fluid is drained out, a drug is put into the tube. This helps seal the space and keep fluid from building up again.

Most of the time, non-small cell lung cancer is treated with radiation or chemo, or with both.

Any type of surgery can have some risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctor know. Doctors who treat people with lung cancer should be able to help you with any problems that come up.

Radiation treatment
Radiation (pronounced RAY-dee-A-shun) uses high-energy rays (like x-rays) to kill cancer cells. In non-small cell lung cancer, it’s most often used along with chemo to treat the tumor and any cancer that has spread. Radiation can also be used to relieve symptoms such as pain, bleeding, trouble swallowing, or other problems. It’s given in small doses every day for many weeks.

If your doctor suggests radiation as your treatment, talk about what side effects might happen. The most common side effects of radiation are:

  • Skin changes where the radiation is given
  • Feeling very tired (fatigue, which is pronounced fuh-TEEG)

Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect.

Chemotherapy
Chemo (pronounced KEY-mo) is the short word for chemotherapy (KEY-mo-THER-uh-pee) – the use of drugs to fight cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body. Chemo is often the main treatment for non-small cell lung cancer. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. This gives the body time to recover. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.

There are ways to treat most chemo side effects. If you have side effects, be sure to talk to your cancer care team so they can help.

Other treatments that may be used

Drugs that stop tumor blood vessel growth: For cancer to grow, new blood vessels are needed to “feed” the tumor. A drug called Avastin® can be used to keep new blood vessels from forming. But it can cause bleeding, so it can’t be used for some patients.

Drugs that target EGFR (epidermal growth factor receptor): EGFR is a protein found on the surface of cells. It tells the cells to grow and divide. Some lung cancer cells have too much EGFR, which helps them grow faster. There are drugs that block EGFR so it can’t tell the cell to grow. They can help keep some lung tumors under control.

RFA (radiofrequency ablation): This treatment uses high-energy radio waves to heat the tumor. A thin needle-like probe is put through the skin and into the tumor. Then an electric current is sent to the end of the probe. It heats the tumor and kills the cancer cells.

PDT(photodynamic therapy): In this treatment, a drug called Photofrin® is put into a vein. This drug only starts to work when exposed to light. Over the next few days, the drug collects in cancer cells. Then a tube is passed down the throat and into the lung. A special light on the end of the tube is aimed at the tumor. It turns on the drug, so it kills the cancer cells.

Clinical trials
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.

Clinical trials are one way to get state-of-the art cancer treatment. They are the only way for doctors to find better ways to treat cancer. If your doctor can find one that’s looking at the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

What about other treatments that I hear about?
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor

  • What treatment do you think is best for me?
  • What’s the goal of this treatment? Do you think it could cure the cancer?
  • Will treatment include surgery? If so, who will do the surgery?
  • What will the surgery be like?
  • Will I need other types of treatment, too?
  • What’s the goal of these treatments?
  • What side effects could I have from these treatments?
  • What can I do about side effects that I might have?
  • Is there a clinical trial that might be right for me?
  • What about special vitamins or diets that friends tell me about? How will I know if they are safe?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • What’s the next step?

What will happen after treatment?
You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back.

For the first 2 years after treatment, you’ll have doctor visits and CT scans every 6 to 12 months, or maybe more often. After that, you will most likely have a doctor visit and CT scan every year.

* Information on this page is from American Cancer Society

Small cell lung cancer (SCLC), which is sometimes called oat cell cancer. About 10% to 15% of lung cancers are SCLC.

Questions to ask the doctor

  • Why do you think I might have lung cancer?
  • Could my symptoms be caused by something else?
  • Would you please write down the kind of cancer you think I might have?
  • What will happen next?

How will the doctor know if I have lung cancer?
Symptoms of lung cancer are cough, chest pain, and trouble breathing. The doctor will ask you about your health and do a physical exam.

If signs point to lung cancer, more tests will be done. Here are some of the tests you may need:

Chest x-ray: This is often the first test  used to look for spots on your lungs. If the x-ray is normal, you most likely don't have lung cancer. If a change is seen, you will need more tests.

CT scan: This is also called a “CAT scan.” A CT scan is a special kind of x-ray that takes pictures of your insides. CT scans can also be used to do a biopsy (see below).

PET scan: A type of sugar is put in one of your veins for this test. Then, pictures of your insides are taken with a special camera. If there is cancer, the sugar shows up as “hot spots” where the cancer is found. This test is useful when your doctor thinks the cancer has spread, but doesn’t know where.

Biopsy (BY-op-see): For a biopsy, the doctor takes out a small piece of the lung tumor. It’s sent to the lab to see if there are cancer cells in it. This is the best way to know for sure if you have cancer.

Bronchoscopy (brong-KOS-kuh-pee): A thin, lighted, flexible tube is passed through your mouth into the bronchi. The doctor can look through the tube to find tumors. The tube also can be used to take out a piece of the tumor or fluid to see if there are cancer cells. You may be given drugs to make you sleep for this test.

Blood tests: Blood tests are not used to find lung cancer, but they are done to tell the doctor more about your health.

Questions to ask the doctor

  • What tests will I need to have?
  • Who will do these tests?
  • Where will they be done?
  • Who can explain them to me?
  • How and when will I get the results?
  • Who will explain the results to me?
  • What do I need to do next?

How serious is my cancer?
If you have lung cancer, the doctor will want to find out how far it has spread. This is called staging. Knowing the stage of the cancer helps your doctor decide what treatment is best for you.

For small cell lung cancer, a 2-stage system is most often used. This system divides small cell lung cancers into limited stage and extensive stage.

Limited stage means that the cancer is only in one lung and maybe in lymph nodes on the same side of the chest.

If the cancer has spread to the other lung, to lymph nodes on the other side of the chest, or to distant organs, it is called extensive stage. Many doctors also call cancer that has spread to the fluid around the lung extensive stage.

If your cancer is limited stage, you might get radiation or chemotherapy (chemo) treatments to try to cure the cancer. An extensive stage cancer will be treated, but is less likely to be cured. Be sure to ask your doctor about the stage of your cancer and what it might mean for you.

Questions to ask the doctor

  • Do you know the stage of the cancer?
  • If not, how and when will you find out the stage of the cancer?
  • Would you explain to me what the stage means in my case?
  • Based on the stage of the cancer, how long do you think I’ll live?
  • What will happen next?

What kind of treatment will I need?
There are many ways to treat small cell lung cancer, but the main types of treatment are radiation, and chemotherapy. In rare cases, surgery may be used. Many times, more than one kind of treatment is used.

The treatment plan that’s best for you will depend on:

  • The stage of the cancer
  • The chance that a type of treatment will cure the cancer or help in some way
  • Your age
  • Other health problems you have
  • Your feelings about the treatment and the side effects that may come with it

Radiation treatment
Radiation (RAY-dee-A-shun) uses high-energy rays (such as x-rays) to kill cancer cells. In limited stage small cell lung cancer it’s most often used along with chemo to treat the tumor and lymph nodes in the chest. Or it could be used on the brain to try to keep the cancer from spreading there. Radiation can also be used to relieve symptoms, such as pain, bleeding, trouble swallowing, or other problems. It’s given in small doses every day for many weeks.

Side effects of radiation treatments

If your doctor suggests radiation as your treatment, talk to him about what side effects might happen. The most common side effects of radiation are:

  • Skin changes where the radiation is given
  • Feeling very tired (fatigue [fuh-TEEG])

Most side effects get better after treatment ends. Some might last longer. Talk to your doctor about what you can expect.

Chemotherapy
Chemo (KEY-mo) is the short word for chemotherapy (KEY-mo-THER-uh-pee) – the use of drugs to fight cancer. Chemo is most often the main treatment for small cell lung cancer. The drugs may be given through a needle into a vein or taken as pills. These drugs go into the blood and spread through the body.

Chemo is given in cycles or rounds. There’s often a rest period as part of each cycle of treatment. This gives the body time to recover. Most of the time 2 chemo drugs are given. Treatment often lasts for many months.

Chemo can make you feel very tired, feel sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends. There are ways to treat most chemo side effects. If you have any side effects, be sure to talk to your doctor or nurse so they can help.

Surgery for small cell lung cancer
In most cases, you will not have surgery (SUR-jur-ee) if you have small cell lung cancer. In a few cases, if the cancer is very small and has not spread, surgery might be done to take out all or part of your lung.

Sometimes, fluid collects in the chest and causes breathing problems. This fluid can be taken out by putting a small tube in the chest. After the fluid is drained out, a drug is put into the tube. This helps seal the space and keep fluid from building up again.

Any type of surgery can have some risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat people with lung cancer should be able to help you with any problems that come up.

Clinical trials
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.  If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.

Clinical trials are one way to the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

What about other treatments that I hear about?
When you have cancer you might hear about other ways to treat your cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to be helpful. A few have even been found to be harmful. Talk to your doctor about anything you are thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor

  • What treatment do you think is best fo me?
  • What is the goal of this treatment? Do you think it could cure the cancer?
  • Will treatment include surgery? If so, what will the surgery be like?
  • Will I need other types of treatment, too?
  • What’s the goal of these treatments?
  • What side effects could I have from these treatments?
  • What can I do about side effects that I might have?
  • Is there a clinical trial that might be right for me?
  • What about vitamins or diets that friends tell me about? How will I know if they are safe?
  • How soon do I need to start treatment?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • What’s the next step?

What will happen after treatment?
You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about this.

For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to tell if the cancer has come back.

For the first year after treatment, your visits may be every 2 to 3 months. You may have CT scans and blood tests. After the first year or so, your visits might be every 6 months, and then at least once a year after 5 years.

* Information on this page is from American Cancer Society

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